Current Events in Medicaid – Know and Understand Your Benefits

We are providing this to help you understand the program that governs your child’s care and our ability to deliver it effectively and comprehensively. While we do our best, you may be better served at Federal Government Clinics if you have a difference of opinion with our policies at First Impressions.

Medicaid only pays our practice about $.28 for every $1 of services provided. • Our ability to continue to provide service is dependent upon the ability of Medicaid recipients to understand that we need to work efficiently and safely. Please call your legislative representatives to express any concerns. The Federal Government has created Federal Dental Centers. • We are a privately owned dental practice that is independent and chooses to participate in Medicaid. It is not required of us to do so, so please understand that we do a great deal to service the children fairly and equally. Our ability to treat these children is being limited as Medicaid Cuts and “ObamaCare” comes into effect. Additionally we do not receive any additional funds to supplement the fees we collect from Medicaid for the services we provide. Medicaid requires that all co-pays must be collected. • It is the policy of Medicaid to create these co-pays and a requirement of the program that we collect them. All co-pays must be paid before any additional services are scheduled. If you have a concern about this, please consider a Government Clinic as they receive Federal money to offset those charges. Medicaid has certain services that are deemed “non-covered.” • We have provided you a non-covered service agreement which you signed. Please review it and understand the fees that may be due prior to services being performed. There are non-covered service agreements posted in all offices. Please read, educate yourself, and understand that policy. If you find a difference, please address the nearest Federal Clinic for financial assistance. We have a no-show and cancel without notice policy. • We will not allow you to continue to receive care here if the following policy is not adhered to: 1) Medicaid recipients must provide us at least 48 business hours notice to cancel an appointment. 2) Medicaid recipients will be limited to two missed or cancelled appointments, and 3) Medicaid recipients must never miss an initial appointment. The Federal Government has provided you with a statement in your eligibility packet stating the same. Appointment times will be limited due to our best practice model. • Due to high no-show rates, limited contract, and a desire to continue to provide this valuable care, we are forced to have policies which allow us to manage our business effectively. There are, and will be, limits on times in which you may schedule appointments. Federal Clinics do not have the same restrictions, so more appointment time options may be available at such a clinic. We make every attempt to create a safe, positive environment for all children here. • Our expectations and policies are in place to continue to do so. If you find our policies difficult to follow or understand, we regret that and ask you to seek care at a Federal Clinic. These programs receive nearly 100% of compensation to provide that option. You are asked to sign many documents and you must take full responsibility to read and understand what you are asked to sign. • We will be happy to review the document with you prior to you signing it so as to address concerns before issues arise. Call your legislative representatives if you are unhappy with these rules. • These are not our rules and policies we are enforcing. However, we are committed to continue providing services for all as long as we can. Unfortunately, a time may come when the unintended consequence of our government limits our ability to do so.

Please understand that we have been a valued and committed provider to our patients for over 25 years. The new policies being enacted by our government leaders are limiting your options for care and may ultimately limit our ability to continue to provide care to Medicaid recipients. We believe that all children deserve equal care and equal access. “ObamaCare” will limit access and create a dual care model. We have been advocating strongly for years that this not be the case. Change in the program will only come from those affected rather than those delivering care inside it. Be proactive, be vocal, and help us maintain what we have come to know – we offer “The Best Care for Kids!” BROWN CO. OCONTO CO. Brown County Oral Health Partnership (Mobile unit) Northern Health Centers: Nicolet Medical & Dental Clinic Green Bay Area September – June (902) 965-0831 15397 Hwy 32, Lakewood, WI 54138 (715) 276-6321 Northeast Technical College Representative Jeffrey Mursau 2740 West Mason St, Green Bay, WI 54307 (920) 498-5450 [email protected] (608) 266-3780 Representative Andre Jacque Senator Tom Tiffany [email protected] (608) 266-9670 [email protected] (608) 266-2509 Senator Frank Lasee [email protected] (608) 266-3512 ONEIDA CO. Marshfield Clinic - Rhinelander Dental Center CLARK CO. 2268 North Shore Drive, Rhinelander, WI 54501 (715) 420-1400 Marshfield Clinic - Neillsville Dental Center Representative 8 Boon Boulevard, Neillsville, WI 54456 (715) 743-1900 [email protected] (608) 266-7141 Representative Kathleen Bernier Senator Tom Tiffany [email protected] (608) 266-9172 [email protected] (608) 266-2509 Senator Terry Moulton [email protected] (608) 266-7511 OUTAGAMIE CO. Tri-County Community Dental Clinic DOOR CO. 9 Tri-Park Way, Appleton, WI 54914 (920) 882-5500 Door County Memorial Hospital Dental Clinic Oneida Community Health Center (Tribal Clinic) 1843 Michigan Street, Sturgeon Bay, WI 54235 (920) 493-1300 PO Box 365, Oneida, WI 54155 (920) 869-4812 Representative Garey Bies Representative [email protected] (608) 266-5350 [email protected] (608) 266-2418 Senator Frank Lasee Senator [email protected] (608) 266-3512 [email protected] (608) 266-0484

EAU CLAIRE CO. PORTAGE CO. Chippewa Valley Technical College Ministry Dental 620 W Clairemont Avenue, Eau Claire, WI 54701 (715) 833-6370 3504 East Maria Drive, Stevens Point, WI 54481 (715) 342-8060 Representative Representative Amy Sue Vruwink [email protected] (608) 266-0660 [email protected] (608)266-8366 Senator Senator Julie Lassa [email protected] (608) 266-8546 [email protected] (608) 266-3123

FOREST CO. PRICE CO. Forest County Potawatomi Health & Wellness Center (Tribal Clinic) Marshfield Clinic - Park Falls Dental Center 5409 Everybody’s Road, Crandon, WI 54520 (715) 478-4313 75 Sherry Avenue, Park Falls, WI 54522 (715) 762-0200 Sokaogon Chippewa Health Clinic (Tribal Clinic) Representative Janet Bewley 3144 VanZile Road, Crandon, WI 54520 (715) 478-5180 [email protected] (608) 266-7690 Representative Jeffrey Mursau Senator Jerry Petrowski [email protected] (608) 266-3780 [email protected] (608) 266-2502 Senator Tom Tiffany [email protected] (608) 266-2509 SHAWANO CO. Stockbridge-Munsee Health and Wellness Center (Tribal Clinic) LANGLADE CO. W12802 County Hwy A, Bowler, WI 54416 (715) 793-5019 Bridge Rural Dental Health Program - Antigo Representative 116 Langlade Road, Antigo, WI 54409 (715) 627-4383 [email protected] (608) 266-3097 Representative Mary Czaja Senator Robert Cowles [email protected] (608) 266-7694 [email protected] (608) 266-0484 Senator Tom Tiffany [email protected] (608) 266-2509 TAYLOR CO. Marshfield Clinic - Medford Dental Center LINCOLN CO. 843 West Broadway Avenue, Medford, WI 54451 (715) 785-8100 Bridge Rural Dental Health Program - Merrill Representative Mary Williams 401 West Main Street, Merrill, WI 54452 (715) 539-8181 [email protected] (608) 266-7506 Representative Mary Czaja Senator Jerry Petrowski [email protected] (608) 266-7694 [email protected] (608) 266-2502 Senator Tom Tiffany [email protected] (608) 266-2509 VILAS CO. Peter Christensen Health Center MARATHON CO. 129 Old Abe Road, Lac du Flambeau, WI 54538 (715) 588-3371 Bridge CHC Great Lakes Inter-Tribal Council (Tribal Clinic) 1810 North 2nd Street, Wausau, WI 54403 (715) 848-4884 PO Box 9, Lac du Flambeau, WI 54538 (715) 588-3324 Representative Representative Rob Swearingen [email protected] (608) 266-1182 [email protected] (608) 266-7141 Senator Jerry Petrowski Senator Tom Tiffany [email protected] (608) 266-2502 [email protected] (608) 266-2509

MENOMINEE CO. WOOD CO. Menominee Tribal Clinic (Tribal Clinic) Riverview Community Dental Clinic W3275 Wolf River Drive, Keshena, WI 54135 (715) 799-3361 820 Two Mile Avenue, Wisconsin Rapids, WI 54494 (715) 424-8575 Marshfield Clinic- Marshfield Dental Center Representative Jeffrey Mursau 1307 N St. Joseph Avenue, Marshfield, WI 54449 (715) 221-5600 [email protected] (608) 266-3780 Representative Amy Sue Vruwink Senator Tom Tiffany [email protected] (608) 266-8366 [email protected] (608) 266-2509 Senator Julie Lassa [email protected] (608) 266-3123